Dear Parents, 

This year, our school is participating in the PowerSavers Challenge.  The challenge is about saving energy at school.

To find out more visit http://tinyurl.com/MarylandPowerSavers

As one part of this challenge we are asking schools to submit videos about saving energy.  We will be awarding $1,000 to the schools that create a winning video.  To be able to use these videos we would like to ask your permission to use images and videos that feature your child.  

Photographs, Videos and Recordings
I hereby grant permission to  	The Alliance to Save Energy 	and its representatives to take photographs or videos of me and to make recordings of my voice during the 2013-14 academic school year as part of the PowerSave Schools program.
First and Last Name (Printed): 	

E-mail: 	  Phone: 	

Parent/Guardian Name (if under age 18): 	

School:  	Date:  	                         
 
I further grant to the producers and their representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later developed. I acknowledge that      _The Alliance to Save Energy       owns all rights to the images and recordings.

Check all that apply:
 	I give permission for my picture to be used
 	I give permission for my picture to be used with my name
 	I give permission for my picture to be used in conjunction with my school's name

Waiver, Indemnity and Release
I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify and hold harmless the producers from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I am 18 years of age or older and I am competent to contract in my own name. I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.

Signature (if age 18 or older)	Date

Signature of Parent/ Guardian (if under age 18)	Date